Allergic rhinitis (AR) is a common disease, especially among adolescents. Dust mite rhinitis
usually develops at the end of preschool age and it is characterized by obstructive symptoms.
AR due to pollens becomes more evident close to 10 years of age and it is mainly
characterized by irritative symptoms (sneezing, rhinorrhea and pharyngeal and oral pruritus)
and associated with allergic conjunctivitis. Pollen rhinitis can be associated also
with the pollen food syndrome that is characterized by oral pruritus and swelling after the
ingestion of raw fruits or vegetables, and is due to cross-reactivity between aeroallergens
and fruits/vegetables. Allergic asthma is also more frequent among patients with AR: in children
with dust mite allergy asthma usually develops before rhinitis, instead in patient with
pollen allergy it usually follows rhinitis. Among dust allergic patients, asthma is usually more
severe and persistent. The diagnosis is usually based on clinical history and positivity of
prick tests; other tests (such as RAST and nasal eosinophilia) should be limited to uncertain
cases. Therapy consists of intranasal corticosteroids and second generation oral antihistamines;
the latter are less effective on obstructive symptoms. In dust mite allergic patients,
allergy avoidance is essential and is based on mattress covers and pillow covers. Specific
immunotherapy should be limited to the rare cases in which standard therapy has not
been enough efficient.
